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Identifying and Addressing the Mental Health Needs of Our Students

Dr. Rebecca Zarko discusses the mental health needs of students who might be returning to schools this fall or continuing with online learning.
Identifying and Addressing the Mental Health Needs of Our Students
Featured Speaker:
Rebecca Zarko, MD
Rebecca Zarko, MD is a board-certified child and adolescent psychiatrist on the Medical Staff at Southwest General.

Prakash Chandran: This Southwest General Health Talk COVID-19 Podcast was recorded on August 20th, 2020. What a school going to look like in the fall? Is my child going to a classroom or staying at home? These are just a few of the many questions every parent is asking as school districts roll out their plans for reopening school in light of continued rising cases of COVID-19 nationwide. The sudden change to remote learning in the Spring, brought change to some students' mental health between the loss of social outlets, as well as the learning environment. Today, we're going to break down some of the major concerns regarding mental health and distance learning as a result of a healthcare pandemic. We're going to talk about it today with Dr. Rebecca Zarko, Child and Adolescent Psychiatry Specialist at Southwest General Health Center. This is Southwest General Health Talk, I'm Prakash Chandran. So, Dr. Zarko, let's jump right in. How exactly do we explain to our kids that this is the new normal? Particularly though for those say kindergarten through third grade, who haven't quite grasped that this virus isn't going away and now is affecting their school experience?

Dr. Zarko: I think it's really important with kids to be primarily calm, reassuring, give them explanation for what's going on, be honest and be straight forward, but you don't have to give excessive detail or get too clinical, and you don't want to increase their fear. You want to be open and honest and answer their questions, but you also don't want to increase their anxiety about the illness. So explaining COVID-19 or Coronavirus like a cold or a flu, something that you transmit from one person to another, usually by sneezing or touching and that people will get ill similar to other illnesses. But it's important to remind kids, particularly young kids that usually when you get sick, most of the time, you end up feeling better after a period of time. So I think after you explain to them kind of that it's a virus like other viruses then you can start talking about how to deal with it as part of the new normal. As opposed to, you know, nobody gets this concerned about having a cold or flu, how is this different? And I think simply just explaining to them that many people are getting this illness. You can even bring in the word pandemic, and explain to them that a pandemic is when many, many people all over the world get the same sort of sickness. And the reason why it's so important or people are talking about it so much is that we're trying to reduce the spread or reduce the number of people that have it. And this is why we're talking about it. And this is why there's so much attention being paid to it. And then you can go into the reassurance of we're doing everything we can to keep safe. The reasons that we're putting all these precautions in place at school and at home and just making them aware that it's a larger problem for more people in the world and it's contagious.

And just like a cold or the flu people get sick, but you will get better most of the time. I think that's the best way to do it. There's a really great step by step sort of cartoon figure storyboard that they have on the American Academy of Child and Adolescent Psychiatry website. It's under the clear answers for all kids about Coronavirus. They have very good resources. I think that's really helpful for people to be aware of, it talks about how it's spread that it's a virus, just like a colder, flu, those kinds of things, the things that we need to do to be precautious, not to spread it to other people. The other thing  like I said, the reassuring that there are a lot of things that are still very normal. Kids can still play and they still go outside and they can still talk to their friends. So it's important to also remind kids that there is a lot of things that are still very normal, despite the fact that we've had to make some adjustments.

Host: I think the way you have articulated slowly breaking down this virus for our youth is very good, you know, just starting and relating it to something that they know. And then slowly getting into some of the differences that this new virus brings. I'm so glad that we're talking about this because I often feel like children and what they're going through during this time, isn't focused on enough. So I'm curious as to your perspective on what you'd say, the largest concern regarding a child or an adolescent mental health or wellbeing in regards to the potential decision of not returning to school in the fall. You know, it's a pretty big thing for them outside of their normal routine and schedule. So what are your thoughts around that?

Dr. Zarko: The things that I'm seeing with the kids and their concerns regarding Coronavirus and how it's going to affect them emotionally, and then how it relates to them going to school, sort of two separate things. So I think in general, regarding COVID kids have a lot of anxiety, not only about getting sick, but getting other people sick, particularly people in their household, a lot of kids have heard about that this virus is worse for older people. So if they're living with a grandparent or they have a parent who isn't well, or has an illness already, they've sort of heard that it could be worse for them. And so they have a lot of worry about, I've heard kids have worry about not being at school or not being around their friends as much. If I'm not going to school, are the kids going to forget about me or they're not going to want to be my friend anymore?

So, I think that there's a lot of worry and anxiety, not only about getting the virus or getting other people sick, but also just losing some of the relationships and connections. School is very important, not only for education, but also social and emotional development, going to an actual school building and interacting with other peers, other adults is very important for kids in their growth and their social, emotional growth. You learn how to have relationships, you learn how to deal with other adults, other than your parents, right? When you don't have that, if you're not going back to school and you're going to be doing it online, you sort of are missing some of that. Along with that comes isolation, with isolation then there becomes concerns about depression. So I think the things that we're worried about what I'm seeing most, as far as the effect on kids' mental health with COVID-19 is not only the anxiety piece, but also the depression piece. I think it's important also to say that if kids have already experienced an episode of depression or are an anxious kid at baseline, they're more at risk. So if you've got a kid that was already an anxious kid or a kid that's gone through depression before, those are kids, that would be more likely to have a problem because they've had that issue before.

Host: Right. And so for us parents, for example, that haven't been through this, what signs or symptoms should we be looking out for that might indicate that our kid is struggling?

Dr. Zarko: So, I think there's a few big ones to look for. One is if your kid has a sudden problem with sleeping, I will say that with the Coronavirus, one of the things that I've seen happen is sleep schedules are off anyway. So most of the kids are staying up late, sleeping in they've kind of lost their schedule, which is another really important point to bring up the importance of trying to have a schedule can be really very reassuring and very helpful to kids, but we can get into that more later. But I would say seeing a change in just the basic functioning, like my kids not eating, they're not hungry. They're not sleeping as well. They're more withdrawn. And really little kids if they start to regress, they're acting much younger than their age. They're more clingy. They're acting more babyish.

In older kids, you can see a change in their moodiness. They're irritable, edgy, that kind of thing, creating more conflict, having issues with following through on things they would normally follow through on. Sometimes you can also see kids get physical complaints that you're not sure that they're really having them. And you're like, well, I know they're not sick, but they're complaining. So I think like a change from the normal functioning, sleeping, eating activity level, signs that their mood is changing, irritable, edgy. They don't want to do as much as they used to do. They're more afraid to do things that they weren't afraid to do before. Things like that.

Host: Got it. And you know, one of the things that I want to make sure to get to is you said that there's the importance of having some sort of schedule for them to give them back some sort of normalcy in their day to day lives. Can you expand on that a little bit more?

Dr. Zarko: Yes. I'd love to. I think that one of the things that parents can do to really help kids with this, because the whole concept of having Coronavirus out there is this sense of something we can't control, right? There's this virus, we might get it. What do we do? There's a whole lot of just anxiety about it in general. So one of the ways that you can help kids cope with it is helping them to feel a little bit more of a sense of control in a circumstance where there isn't a lot of control. So one of the ways to do that is having a schedule. Kids in general do better when they know what's coming next, when things are predictable, when things are the same, it's reassuring to humans, and especially kids, to know what's coming next. It reduces anxiety in and of itself, regardless of whether or not we're dealing with COVID or Coronavirus or whatever.

It's helpful. So now more than ever, it's really important to have a schedule, to have a routine, to sort of put that in place. And as I was mentioning before, because schools were shut down at the end of last year, a lot of families got off schedule, sleep schedules weren't the same school schedules, you could do it at any time that you wanted. You didn't have to go and do your schoolwork at a particular time. So a lot of the schedules kind of went out the window the last school year. I think that's really, really important thing to point out that if you don't have a schedule going, or you don't have a routine, implement one, because not only will it help you to feel organized, but it will also reduce that anxiety in your kid by giving them a sense of control. What that brings me to next. The other thing that you can do to help kids feel like they have some control over the situation, even though they don't really, is about taking responsibility for prevention, what can I do?

What can you do as a kid to protect yourself and protect us and keep safe? So the whole washing your hands, wearing a mask, being healthy, let's eat healthy, let's get enough sleep. Let's do regular exercise. When you actually are doing things proactively, I'm eating healthy, I'm exercising, I'm getting my good rest. I'm going to bed. I'm taking care of my body. I'm wearing a mask. I'm washing my hands. These are proactive things that you as a kid can do. And you as a parent can do it and be a role model to your child. And it gives you a sense of I'm doing something that I can control, that in a world that seems uncontrollable. It gives me a little sense of control. And as a result of that, it can decrease a lot of the anxiety.

Host: Yeah, these are all really good tips. We've talked about the importance of introducing or implementing a schedule, having them be proactive and kind of making them part of the solution. I really like that. And then really on the whole, just giving them a sense of control in a world that just seems to have none of it, beyond all of that. Are there any final tips here as we close that you can give parents to just help their kids cope with the circumstance?

Dr. Zarko: I think a couple of things. I think one it's really important to try to have some sense of normalcy, to try to do things that you would normally do in a pre COVID world, as much as you can. To try to focus on positive where you can. I think these are teachable moments for resiliency and flexibility. You can use this as a teaching point with your kids to say, you know, in life there's challenges, there are things that we all have to get through and deal with and we are strong and we can do it. And we work together. And when we work together as a family, as a community, we can achieve good things. We can get through anything. So I think that it's important also to point that out. And then really the other thing that parents can do is you can also help to reduce isolation by helping kids to stay in touch with their friends, virtually socially distancing, try to counteract that isolation, where you can, the other thing families are on top of each other. They're all together spending a lot of time together, which can be very good, but it can also be a bit challenging. So allowing that individual space for kids, members of the family is not a bad thing. If you need to take a break and have some alone time and some quiet time yourself, because you've just had too much interaction, but that's okay.

The biggest things are to let them talk, let them ask questions, validate their feelings, let them know it's okay to be upset, to ask questions, talk about ways to manage stress and be a good role model to your kids. There's a few really good resources that I would say. I mentioned in the beginning, the American Academy of Child and Adolescent Psychiatry has many, many, many resources about talking to your kids about COVID-19. I mentioned earlier about the cartoon kind of storyboard on that. They also have really great ideas for what you can do with your kids to decrease isolation. It's a wonderful, wonderful resource. The website is So I would encourage people to go there. It's very easy. The other one that I would say is really good is So the Centers for Disease Control, they have a very good school decision making tool for parents. So if you are trying to decide whether or not to send your kid back or keep them home or whatever, it's a very nice checklist that goes through how to make that decision in a very responsible and informed way that you can feel good about. So I think those two resources, I would say are things that I would definitely check out as a parent.

Host: Well, Dr. Zarko, I truly appreciate your time today. This has been hugely informative and I think this is the perfect place to end. That's Dr. Rebecca Zarko, child and adolescent psychiatry specialist at Southwest General Health Center. To learn more about Southwest General Health Center visit We hope you found this podcast helpful. Please share it on your social channels and check out our full podcast library for topics of interest to you. Thanks so much again, and we'll see you next time.